Medical Waste
written by: Carol Abernathy, Delin Johnson, Stephen Robinson, Valerie Roddy
Every year, the United States produces approximately 3.2 million tons of medical waste, which includes blood and human waste, used needles and other "sharps," pathological and infectious wastes, "isolation" waste (i.e. waste that could spread highly communicable diseases) and some cytotoxic waste (i.e. chemotherapy byproducts). Tulane University generates all of these types of waste at its many facilities, the most notable being the Tulane University Medical School, the School of Public Health, the University Hospital, and the Student Health Center.
Why did Tulane University receive a C on the grade sheet on the preceding page? The most critical area of concern with regard to medical waste is the availability of information. Tulane did not receive a failing grade in this area for one reason only: it does not appear that the administration is covering up information; rather, it seems that the information is just not available and may not even exist. In fact, many administrators at the hospital and at the health center were willing to provide names and telephone numbers of contacts who "might have that kind of information," adding, "we don't really keep records of that kind of thing here." The major consequence of not keeping records of much of the information we asked for is that it makes it difficult to recommend more environmentally sound policies. For example, Tulane does not monitor medical waste carefully and there is no record of how much harmless waste is treated as medical waste. Administrators could reduce volumes incinerated and landfilled waste by recycling harmless wastes that are currently disposed of as medical waste, if such waste exists. However, the lack of monitoring of medical waste has not hurt Tulane University in the areas of workplace safety or adherence to environmental regulations. No incidents were uncovered during extensive research on the subject, and Tulane disposes of its medical waste in appropriately labeled colored medical waste containers, which are incinerated and landfilled as recommended by the State of Louisiana Department of Environmental Quality. In many ways, Tulane's high grade for adherence to environmental regulations is not of monumental significance because the state DEQ has not set particularly extensive or rigorous standards in this area.
Tulane University contracts its medical waste disposal through Browning Ferris Industries (BFI). BFI is the world's second largest waste management firm (second only to WMX Technologies) and operates 104 solid-waste landfills, 32 medical waste treatment facilities, and 125 recycling facilities on this continent. They operate in 45 of the 50 states and in 14 foreign countries. Its fastest growing business is in recycling, which accounts for more than 10% of its current revenues. Solid waste transfer and disposal makes up another 20% of its business. The firm, generating revenues of over $5 billion a year, employs 37,000 people. Like all of the other major waste disposal firms, Browning Ferris Industries is frequently in the news. However, most of these articles are the common tales of NIMBY (Not In My Back Yard) movements fighting landfill zoning in their communities, and this hold true for all of the major waste management firms. In some cases, BFI has proved to be more responsible than other firms. In the District of Columbia, where city planners failed to adequately regulate landfill zoning, only half of the firms that benefited from easily granted interim permits even paid all of the city fees in full; Browning Ferris was one of those firms. BFI is also an "industry ally" of the EPA's Landfill Methane Outreach Program. The goal of this program is to collect landfill gases and convert them to energy. Most sites must collect the gases anyway because it is almost 50% methane. Site operators can then produce energy from the gas either for sale or on-site use, displacing some unnecessary use of fossil fuels. However, there are means of treating medical waste that are more atmospherically sound than large-scale incineration. Many small firms and health care facilities that treat their own medical waste are adopting these alternatives because updating their incinerators to meet the stricter regulations set by the EPA is too costly. The three alternatives are autoclave, microwave, and chemical treatment. Autoclave, a steam process, has been the most successful alternative by far. Large firms, like Browning Ferris Industries, however, can afford to update their incinerators so that they conform to EPA environmental regulations. Given the size of Tulane University's medical programs, it is unlikely that Tulane could contract a smaller waste management firm and might have merited an "A" had it not been for BFI's hesitancy to provide
Recommendations for change:1. One policy that could cut down on waste without destroying the cost-effectiveness of using a major firm like BFI is using reusable medical waste containers that simply have disposable liners, the famous "red bags" instead of "red bags" inside of disposable containers. This remedy could make a difference while being less controversial than using reusables in other areas of the medical industry.
2. Monitor medical waste closely to ensure that medical forms and other harmless hospital wastes are recycled instead of incinerated and landfilled. Reducing quantities of waste treated as medical waste unnecessarily is also more cost efficient.
3. Publish an annual environmental statement that makes information available not only to the general public but perhaps more importantly, to hospital and clinic administrators and staff. It is a sound business practice to know important information about any business, especially something as complex and extensive as a hospital or even a medical school.
4. Purchase more recyclable or reusable medical goods and less disposable products. Not everything that is disposable in the medical industry needs to be disposable. However, this policy is harder to enact than it would seem; the University hospital, for instance, is actually managed by a conglomeration of health care facilities called the Columbia Corporation, based in Nashville, and it is the Columbia Corporation which actually makes all purchasing decisions for the hospital.
Figures on the volume of medical waste that Tulane produces are unavailable. Because Tulane apparently does not even keep its own record of this information, BFI is the only source for this data and so Tulane receives an "Incomplete" in this area.
Tulane appears to be making an effort, however. Rumors abound that an on-site medical waste disposal facility that is more environmentally friendly will soon be built behind the medical school. Furthermore, it is important to consider that the health care industry is universally wasteful by nature because of fears of contamination.
Overall, it appears that Tulane University, while not exerting significant effort in helping the environment, is in no way below average in its medical waste procedures. It conforms to regulations and is a safe workplace environment. However, medical waste should be an area of significant environmental concern to University administrators because of the large scale of Tulane's medical facilities and because of the health care industry's preference for disposable products over recyclable and reusable products. By adopting any of the aforemantioned recommendations, Tulane could make significant strides towards environmental consciousness.